THE ABDOMEN. 39 



another case an accumulation of faecal matter in the sigmoid 

 flexure during life was mistaken for a malignant disease. 



85. Colotomy. The operation of opening the colon 

 (colotomy) may be done in the right or left loin, below the 

 kidney, in that part of the colon not covered by peritoneum. 



The landmarks of the operation are : (i) The last rib, of 

 which feel the sloping edge; (2) the crest of the ilium; (3) 

 the outer border of the ' erector spinae.' The incision should 

 be about three inches long, midway between the rib and the 

 ilium. It should begin at the outer border of the 'erector 

 spinae,' and should slope downwards and outwards in the 

 direction of the rib. The edge of the ' quadratus lumborum,' 

 which is the guide to the colon, is about one inch external to 

 the edge of the ' erector spinae,' or three full inches from the 

 lumbar spines. The line of the gut is vertical, and runs for 

 a good two inches between the lower border of the kidney 

 and the iliac crest on the left side ; rather less on the right. 



Small intestines. All the room below the umbilicus is 

 occupied by the small intestines. The coils of the jejunum 

 lie nearer to the umbilicus (one reason of the great fatality of 

 umbilical herniae). Those of the ilium are lower down. 



On the right side, a little below the ninth rib, the colon 

 lies close to the gall bladder, and is, after death, sometimes 

 tinged with bile. Posteriorly, this part of the colon is in 

 contact with the kidney and duodenum. 



86. Bladder. When the bladder distends, it gradually 

 rises out of the pelvis into the abdomen, pushes the small 

 intestines out of the way, and forms a swelling above the 

 pubes, reaching in some instances up to the navel. The out- 

 line of this swelling is perceptible to the hand as well as to 

 percussion. More than this, flucfuation can be felt through 

 the distended bladder by tapping on it in front with the 

 fingers of one hand, while the forefinger of the other passed 

 up the rectum feels the bottom of the ' trigone.' 



